Participants' perceptions of the factors that influence diabetes self-management following a structured education (DAFNE) programme

Aim: The aim of this study was to understand the experience of participants in the Dose Adjustment for Normal Eating programme and to identify factors that influence participants' implementation of the self-management guidelines.

Background: The literature revealed that structured education programmes, such as Dose Adjustment for Normal Eating programme, have many positive outcomes for people with Type 1 diabetes including: a decrease in HbA1c levels, reductions in hypoglycaemic events, reduction in hospital admissions and increased and sustained quality of life. Few researchers, however, have gathered participants' perspectives on the impact of participation in a Dose Adjustment for Normal Eating programme on self-management capacity.

Design: A grounded theory design focused on description guided by Corbin and Strauss was used. Data collection and analysis were concurrent using the constant comparative technique.

Methods: Over 24 months, 2006-2008, interviews were undertaken with 40 participants who had completed a Dose Adjustment for Normal Eating programme in one of five study sites across Ireland. Purposive sampling was used, initially, with theoretical relational sampling towards the end of the interviews as concepts emerged. The interviews lasted from 30-60 minutes and were transcribed verbatim.

Results: Five factors that influenced participants' self-management of their diabetes following dose adjustment for normal eating were identified. These were knowledge, support, motivation, relationship shift and empowerment, and these were all related to the core category, 'Being in Control'.

Conclusion: Understanding the factors that influence self-management in Ireland is important as it broadens prior knowledge and confirms the factors that are important to facilitate self-management.

Relevance to clinical practice: Understanding the factors that influence the implementation of dose adjustment for normal eating principles can help health professionals give more focused and empowering care to persons with diabetes. Using the persons' experience and expertise is essential as it can help them develop their internal resources.